NOTHING BUT THE TOOTH: Tooth-colored fillings are often not the right choice

By Dr. Richard Greenberg

Friday

Jul 27, 2018 at 7:55 AM

Along with gold and silver amalgam, another restorative material is gaining popularity in this country and all over the world. There are a number of different types, with different formulas, some purportedly better than others. I refer to them collectively as non-metallic tooth-colored materials. The questions from you, the readers, all had the following in common.

Q. I went to the dentist and need a filling. I do not want one of those metal ones. I do not want to see metal in my mouth. No particular reason, I just do not like them. Shall I have my dentist use a tooth-colored material?

A. You have every right to choose a tooth-colored restoration (filling) but first, I would ask your dentist to carefully explain the advantages and disadvantages. Color may be a desire on your part, but to possibly compromise the result because of that desire might not be the decision that is best for you and your dental health.

When a dentist places a restoration, the object is to put back what was diseased and restore the tooth to ideal form and function. As doctors, we are concerned about accomplishing just that without causing additional damage to your tooth. We want to restore the tooth in a very atraumatic manner so that you will be comfortable after its placement and the desired result will be achieved.

The dental material chosen should be capable of enduring the stress of chewing, to hold up under stress of para-functional habits like clenching and grinding, to be placed with competence by your dentist and lastly have a reasonable cost. We dentists have always seen the need to choose tooth color in restorative materials but only in very isolated areas of your dentitions. Recently, because of society's overwhelming desire that everything must look good, dentists are being asked to place these materials in areas that, I believe, will ultimately be detrimental.

The use of these materials of tooth color should be discussed with your dentist but suffice it to say, tooth color is a secondary requirement for a filling material and other requirements are far more important. To mention just a few, ask your dentist about how long tooth-colored fillings will last, how much they will they cost and if he or she is comfortable placing them. The answer might be that these materials take more time and effort to place and as a result are more costly to you.

The most-damaging fact is that in most cases, even with the greater time and cost, they will fail in a much shorter period of time than their metallic counterparts, necessitating their replacement, which requires more time and more money. Indeed, gold can last forever and silver depending on its size also can last for a very long time. Tooth-colored materials only in very rare instances have the potential to last as long as metals.

Do not forget that restoring a tooth is a surgical procedure. To do that properly, just like any other surgical procedure, the dental surgeon needs to be able to perform the surgery comfortably and achieve a good outcome. You, the patient, deserve as perfect a result as possible. I will say categorically that for your dentist to accomplish that feat using tooth-colored materials will take an uncommon level of expertise. As we know, human beings do not all possess the same skill levels, and although it might be possible to achieve the same surgical result with directly placed tooth-colored materials, it is extremely difficult and extremely challenging. These materials handle in such a way that make restoring a tooth to ideal form and function far more difficult than with the use of silver amalgam. Silver amalgam is far more user-friendly for the dentist to place.

If you have had a “white” filling placed, the manufacturers of that white material recommend that it be placed in a completely dry environment. That is very hard to achieve in the oral cavity. The best way to achieve that is with what is called “a rubber dam” or a dental dam. It is a somewhat complicated, time-consuming way for your dentist to isolate your tooth from the rest of your mouth so as to achieve the desired manufacturer directed result. Was that done by your dentist when the filling was placed? Do you remember a piece of rubber covering your mouth while the procedure was being performed? If not, ask your dentist why not and how he or she was then able to satisfy those strict guidelines for placement.

Any deviation from the ideal will cause an even shorter lifespan for that restoration. Isolating a tooth with a rubber dam prior to surgery is taught to every dental student in the country. For some unknown reason, probably time and therefore money, the use of the rubber dam is largely abandoned when the practitioner begins practice. It would be worthwhile for you, the patient, to ask why. The use of this method of isolation prior to dental surgery is recommended for all materials, silver and gold as well. Proper adherence to ideal technique will improve lifespan for all restorations.

Always keep in mind that if a filling needs to be redone for any reason, it will then be damaging to your tooth as well as your pocketbook. Even if your pocketbook is very full and money does not matter, having to redo a filling in any tooth is damaging and can lead to possible nerve damage and if so, root canal treatment and even possible loss. As dentists we desire to perform a surgical procedure once, do it right and not do it again. The best dentistry is and always will be no dentistry. To use a material that might compromise that desire does not seem like the ethical thing to do.

To conclude, I will say that you, the patient, and your dentist have to think long and hard about the best choice of material to give you the best outcome. There is no question that tooth-colored materials have a place in dentistry, but to choose them as the routine material where cosmetics are of no import will lead for you in particular, and the population in general, having to endure many more surgical procedures as the years go by. Maybe good for the dentist’s pocketbook but not so for yours and your tooth.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question? Email him at dr.richard@nothingbutthetooth.org.